Since my last missive I’ve been traipsing around Africa - in Tanzania in the bush and up Kilimanjaro, and then back to Kosi Bay and Mozambique and finally made it down to Cape Town. Actually, been back in Joburg for a little bit now, but in the midst of getting back settled, have put off the all-important catch-up email and now have put it off so long that I’ve been to Mexico with the family as well, so figured I’d send the Kili catch up first.

Went up to Tanzania at the end of October to finally climb Kili. Sort of a last minute decision as friends of mine had already booked the trip and I joined up about a week before they left. Had to fly into Tanzania early because my visa was running out and I need to leave the country before it did, so I hopped on a plane early and arrived with a week to explore before the rest of the gang arrived. Typical African flight, we had a little puddle jumper that landed in Dar e Salam and Zanzibar before finally landing in Kilimanjaro airport at about 9pm. It was a bit of a surreal drive along the dark road to Arusha – lots of people walking, cows, etc. in the pitch dark - with my driver in the Landy (I think the Land Rover was more for effect than necessity). Got to the Arusha Hotel, which was very posh (in fact too posh for me, but crashed there for the night anyway since didn’t know where else to head in the middle of the night!). Awoke to the slow city of Arusha – where UN workers at the Rwanda Tribunal, locals, tour guides, and ‘fly catchers’ trying to rope in tourists for climbs of Kili and Mt. Meru and safaris, all mill about on the dusty streets. It’s a very “African” city, not like any city in South Africa. I meandered around on the first day and popped up at the office of the agents that had arranged our tour to Kili. Äke, a cool Kenyan-born guy, was great and since I couldn’t afford the full tour of the Masi Mara and Serengeti (another tine), I arranged to go to a remote bush camp on the border of Kenya in the shadow of Kilimanjaro on the other side the next day. For the rest of the day I set on a mission to find a little more reasonable accommodation and see the sights. It was so nice to be able to walk the streets without much fear of being mugged or attacked – one of the serious downsides to living in Joberg is that you can never walk around. So I meandered and snacked at a café in town that Äke had recommended – very cool, attached to an old German fort, and having the best Belgium fries with homemade mayo ever! Knowing my previous disposition for getting in trouble while traveling alone, I was trying to be careful about ending up in a sticky situation, but was pretty uneventful as I found a backpackers down the road with a cute little Tika Tika art shop and moved from luxury to roughing it.

Got picked up bright and early by my driver, Joseph, and we set off around the mountain in a Landy. Roads aren’t the strong point of Tanzania normally, but considering how far into the bush we were going, the 5 hour drive wasn’t bad. Hemingway Camp was just like the days of Hemingway himself – no running water or reliable power (although some solar power), still lighting the paths with kerosene lanterns. On the border of Kenya and Tanzania, where the Ambroseli Game Park on the Kenyan side is. The border was ‘marked’ with little concrete pilings – one minute in Kenya, one minute you’re in Tanzania. It was the dry season, so the plethora of animals had yet to appear, but you could tell that the rains were coming. The earth was so parched it was actually crazed with cracks. I had my daily lessons in tracking as we wandered through the scrub before breakfast every morning after getting up and climbing up the hill behind camp to see the sun rise. With no mountains to obscure it, the sun rises like a crack over the immense landscape and it’s a sight to behold. We even saw a kill one morning from on top – a flury of dust and then it was over. Overall, it was an amazing week, although I was the ONLY guest out there, so with 10 staff of local dudes to entertain the whole time, I think a week was enough (I could only say, “so…how cool were those elephants today?” so many times.) Got a marriage proposal from the camp manager, who was looking for a “nice white girl” to marry. I think he’s been out in the bush too long. My typical day consisted of getting up to climb and see the sunrise, game walk with the elis, giraffe, wildebeest, sprinkbok, gray’s and zebra, breakfast, game drive with Joseph and my Masai guide, back for lunch, nap/read til 4pm, another game drive, sundowners and then dinner by the fire and to bed early.

In addition to tons of elephants and giraffe, also visited a Masai kraal or village. The Masai still live nomadically, tending their cattle. Actually, they believe that all the cattle in the world belong to the Masai and are theirs for the taking. They survive drinking their milk and their blood, which they get from a cut to the jugular vein. They are a beautiful people, the kraal we went to had two families. Two old men and all their wives. Flies were everywhere and I couldn’t help but have the Western abhorance of them all over me once we stepped through the briars serving as the perimeter. It was a little awkward since I was the only tourist there, but my Masai guide served as interpreter as we chatted with one of the wives. 32 years old (she thinks, but isn’t sure), 6 kids. We sat in her tiny little hut, which was dark and smoky. The Masai don’t like drafts. All the women of the kraal set up a little market for me (ok, so it was a blanket on the dung), and I felt bad that I couldn’t buy more of the stunning beadwork, but also didn’t feel the need for a huge warrior's necklace. I left with a few bracelets and lots of pictures.

At the end of the week I’d discovered that Joseph was an avid birder, so had him excited by writing down the myriad of birds we saw (to accommodate my memory deficiency) and pointing them out left and right. This served to occupy us for the hours back to Arusha through the rain – past the lorry trying to make it up the hill with whole town trying to stop the truck from sliding in the mud down the road, past the little towns of shacks with markets, and the locals leading their laden donkeys and reticent goats.

Back in Arusha, Garron came in on the late flight and it was nice to have a friend in the mix again. As many can vouch, I’m not the best solo traveler, so was lucky to have a pretty uneventful week on my lonesome. Garron’s one of my first friends from when I was first in South Africa years ago. We were meant to get up to altitude for the weekend since Garron was coming from Cape Town, but the weather was pouring buckets the next day, so we decided to go on a business excursion instead – sussing out the market for African hair extensions at the local shops (Garron started his own African hair business in CT about 10 years ago). Very fun to see how the market works, except Garron kept asking random strangers if he could photograph their heads for their hairdos and people thought we were totally weird white people. Never done that before. Anyway, the brothers Petersen, Ed and Nick, arrived the next evening. We took the gang out to my new local hang out, courtesy of Ake, and watched a random avent guard French play (spoken in French, of course) for about 10 minutes before resorting to card playing and imbibing the local brews – Safari, Tusker and Kilimanjaro – all yummy.

We all met the rest of the Kili contingent the next day at our new digs down the road amidst the coffee plantations – River Lodge. Right on the river with lovely grounds and rooms and an open-air dining room. Johann, the modern-day adventurer working for CC Africa, Rubin and Belinda fresh in from Sand Diego/Los Angeles and a Kiwi couple rounded out the group. Ake from Hoopoe briefed us at the Lodge and we tucked into our last (or so we thought) decent meal before setting out for the trek up the mountain. Since I had merely thrown anything remotely warm I had with me down here in a pack, I hoped that it would be enough as I quickly learned that those living in the States had been fully equipped by trips to REI – oh how I miss that store! I couldn’t even find anything fleece in SA in late spring!

The drive up to the base of the mountain to the Machame Gate the next morning was beautiful, through tiny little villages and past coffee plantations. It’s actually quite wet at that altitude and everything is green green. We were hiking the Machame Route – known as the most beautiful. As we tumbled out of the vehicles that took us to the jumping-off point, I realized that this was more than the ‘basic’ trek up Kili – we had about 50 porters for our small group, plus guides. The porters all rushed up to parcel out the luggage, tents, food and various other necessities. Flamingo, so called for his long and lanky build, gave me a grin as he scooped up my pack and stuffed it in his bag to go up. As the porters got a head start, we were delayed signing in, as we would have to do at each camp, and organizing. But finally, we started out and took the first step through the low rainforest that covered us the first day. Luckily, it wasn’t raining. The last two weeks’ treks had had constant rain from day one, and everyone I knew who when through the forest usually got poured on. That was the first day of some very good weather luck for us!

We hiked up through the forest on a very well-maintained trek, serenaded by the birds that stayed just out of our sights and the porters, who occasionally broke into spontaneous song. We paced slowly, getting the hang of the slow pace the head guide set and the constant demand of “maji, maji” for us to drink water. The hike up to 3,000 meters to camp was nice and pleasant, and the surroundings of the huge trees and flowers in the rainforest made for nice sights along the way. The pace and wide trail also gave us the opportunity to get to know each other better. The Kiwis started off the bonding by teaching the porters and guides the Haka, which they took to immediately and for the rest of the trek, all would spontaneously erupt into “Hukaka, hanana…”

We reached camp by the Machame Hut at 3000 meters around 4pm. As the first person stumbled in, the porters sprang into heated song and dance, and we thus found out the lovely greeting we would receive each night as we took that last step in. Amazingly, after running up the mountain ahead of us and setting up all the tents and starting supper, they looked more rested than us who had only to bear the weight of our daypack and slowly prod up the path. Camp had it all, a huge dining tent to have meals in all together, separate toilets so we could avoid the “long drops” (scary since you’re always worried YOU are going to take the long drop in), and all our sleeping bags and mats neatly laid out. Felt like a 5-star hotel, or at least the equivalent on the top of a mountain.

From Machame Hut we set out for Shira Camp early in the morning. We left the rainforest behind and traversed up to a more sparcely vegitated plateau. Lunchtime found us all enveloped in thick fog and the tents set up for lunch appeared suddenly in the swirling mists. It was quite surreal. The hot soup was a welcome balm for our chilly bodies.

24^th October 2006 KILIMANJARO - SHIRA

Rising early you cross a valley and a stream and then climb up a steep ridge for 3-4 hours. The path then drops into the river gorge before you climb more gently onto the moorland of the Shira Plateau, one of the most fascinating areas of the Mountain. Overnight camping in mountain tents by the Shira Hut (3,840m). (Full board)

25^th October 2006 KILIMANJARO - BARRANCO

Today you will walk for 5-6 hours, enjoying sightings of the typical Kilimanjaro mountain vegetation (Senecios, Lobelia, Helichrysum) and rewarding views of the spectacular Barranco Valley. Overnight camping in Mountain tents by the Barranco Hut (3,950m). (Full board)

26^th October 2006 KILIMANJARO - KARANGA

From the Barranco Hut, you ascend up the Barranco wall and walk across scree and ridges to Karanga valley(4,100m) with breathtaking views of the West Breach and the southern glacier. Lunch is often taken here, depending upon progress. In the afternoon there is then the chance to head up Karanga Valley to aid acclimatisation, or simply relax in camp as required. Karanga Camp (full board).

27^th October 2006 KILIMANJARO - BARAFU

About 2 hours from Karanga you will come out on the Barafu path (part of the Mweka Trail). It is a further 1-2 hours to Barafu Hut. The last stage to Barafu hut is quite steep, and as always we advise taking it as easy as possible. Being as relaxed as possible both mentally and physically is the best advice (physical relaxation is often as difficult as mental relaxation!). We often try to camp a little higher (around 4700 meters) when possible to make the morning ascent that little bit easier. In the evening you will be briefed for the final ascent, and preparing clothing and water before you rest for the night is a good idea to give you a good start in the morning. Overnight Barafu Camp (Full board).

28^th October 2006 KILIMANJARO – SUMMIT - MWEKA

You rise early in the morning and begin your climb to the summit. You pass through the gap between the Ratzel and Rebmann glaciers and continue to Uhuru peak (5,896 m) where you can watch the sunrise from the rooftop of Africa! You then descend to Mweka Camp for your overnight stay in Mountain tents (3,100 m). (Full board)

29^th October 2006 Kilimanjaro – Mweka - Arusha

Today you descend to the Mweka Gate and then continue by vehicle to the Rivertrees Lodge. It’s time to relax, take a hot shower or a swim in the pool before a final dinner with the other members of your group to celebrate the achievement of conquering Mount Kilimanjaro. Overnight Rivertrees Lodge. (Full board)

30^th October 2006 Arusha

Johann Van Zyl will be transferred to Arusha Airport in time to connect with the 8.00 hrs Regional Air scheduled flight to Serengeti (booked direct) (breakfast only)

Belinda Smith and Ruben Spilken will be transferred to Kilimanjaro International Airport in time to connect with 21.45 hrs KLM flight (Breakfast only)

Ed & Nick Petersen and Jennifer Anderson & Reynolds Garron will be transferred to Kilimanjaro International Airport in time to connect with the 8.00 hrs TC7908 flight (booked directly) (breakfast only)

Visiting Hospitals in the North West Province

Hello to all from the deepest, darkest Africa…well, not really the deepest and darkest, sometimes I forget I’m in the third world with all the malls and fancy cars around Joberg. I’ve been here almost two months now, which I can hardly believe. Between dial-up internet and lack of cheap phone cards, I’m afraid I’ve been incommunicado as well. I keep starting emails with the latest and running out of steam halfway through. Sadly, I’ve resorted to setting up at the local McDonalds, which is one of the 2 places in town with free wireless internet – sad state of affairs since as an American I feel the obligation to stay as far away from McDonalds as possible to avoid any stereotypes (that and not being a huge fast food fan).

After getting settled, spent a lot of August driving around South Africa with work, Kwazulu Natal one week, the Northwest Province the next- two provinces I hadn’t been two before. RHI is also currently going through a sort of coup de etat, trying to break away from the Academy of Family Practice, the organization it’s been working under, so it’s exciting trying to figure out how to do that – lots of politics and egos involved apart from figuring out the logistics of setting up as a separate entity.

A few weeks ago, Bayanda (another member of the Rural Health Initiative crew) and I set off to take a tour of the rural hospitals in the Bophirima District of the Northwest Province – about 4 hours due west of Johannesburg – to get a better picture of the rural hospitals there to assess their needs and suitability for RHI-recruited doctors. I had never been to the Northwest, which is on the border with Botswana, so I was excited to see it. Bayanda, her 9-month old son Mila, Mila’s nanny Madisa and I piled into the car on a Sunday afternoon and set off on the N14 to Vryburg in order to make a meeting with the district health officials early on Monday morning. The Bophirma District consists of the municipalities of Greater Taung, Kagisano and Molopo, Moshaweng, Lekwa Teemane, Mamusa and Naledi…African names that this American tongue butchers consistently and my American brain has a hard time remembering, the letters all just seeming to jumble together. Despite the richness of the names, the Northwest is actually a dry (now that it’s winter) and empty space where the wind is often your only company on the straight-for-miles roads. Reminded of the Texas Panhandle (maybe because I had just finished reading an Annie Proux book set there and the windmills sparked a resonance), we drove for miles across the flat landscape of grassland and small signs signaling turns down dusty roads to unseen farms, until eventually even the road signs stopped directing our way on the N17 about halfway there and we had to resort to the old fashioned method of asking people alongside the road which was the way to Vryburg, our ultimate destination and base of operations for the week. “Bieslesvlei, Delareyville, then Vryburg” a withered and dusty man told us at the stop street in a one-horse town (or half-horse town, if there is such a thing, it consisted of a bar) near Coligny. One defining characteristic of the roads in Africa is there are always people walking, day or night, although where they’re walking to or from is often a mystery given how far the nearest settlement seems to be.

Following the signs to Bleslesvlei, then the signs to Delareyville, we rolled into town just after dark and pulled up to the International Hotel, what made it international I don’t know since it looked unlikely that anyone besides me would go out of their way to leave their country and come here. But quaint and decidedly Africaans, it was nice to have a place to stop and unload. The International was one of those hotels where the carpet is blue and the furniture is from the 1960s, but it was clean and safe, so we were happy. Bayanda had told me horror stories of the hotel she and Saul had stayed at during their last trip to visit hospitals in Limpopo. After unloading, we forayed into the dining room. Old faded pictures and stories from the turn of the century lined the walls – apparently an outlaw had once set up camp here and escaped through the stables when pursued by the law. We sat down at one of the four tables there and

We had coordinated our visit with the district’s annual review of hospitals being conducted that week. On Monday morning, Mr Modise, an employee of the district health office, accompanied us to Ganyesa, where the roving management team was meeting to begin their hospital and clinic visits for the review. We were warmly welcomed by the District Director, Mr Konrad Mothlabane, who introduced us to his management team that included hospital CEO’s, Clinical Managers and officials at the district office, all gathered around the boardroom table. While we had thought we were just there as observers, Mr Mothlabane had other ideas and escorted us to the front of the room and sat us down at his right near the head of the table. He gave us a brief presentation of the hospitals and health centres in the district before we grabbed a quick bite of breakfast (idyllically unaware that these pieces of hasty toast would be our only sustenance for the rest of the day) with the group and left on our tour. Mr Modise kindly agreed to be our “chief marshal” and escort us to and around the hospitals for the three days we were in the province.

Ganyesa Hospital

Our first stop was Ganyesa Hospital, just outside the small village of Ganyesa (if you can call it a village…mostly it was just a gas station and a small collection of shacks). Ganyesa is a real rural hospital, with nothing as far as you could see on either side of the grounds, although the hospital was tidy and neat and the staff lacked the desperate air we found at some other rural hospitals. A nice young doctor that grew up in the area showed us around. As he told us, there’s really nothing to do for fun around, the nearest town being Vryburg where we came from, about 100km away. One of the doctors’ seems to have taken up breeding Dachshunds, since about 20 of them – puppies and adults all running hairy-scary about - accosted us as we strolled by the doctors’ houses.

Tshwarangano Hospital

Our next stop was Tshwaragano Hospital in the Kudumane district. After much debate, we decided to take a “short cut” via a gravel road and two hours later arrived at the hospital - saving kilometres but not much time and comfort as our teeth still chattered when we alighted from the car. Tshwaragano Hospital is an old mission hospital on the very edge of the province. It’s in desperate need of an upgrade, the buildings were literally falling down around the hospital. The present hospital buildings and staff are struggling to accommodate the patient load as the hospital has 214 beds and is a referral centre to about 28 clinics and there are only four doctors on staff- pretty grim. This is partly because the government is moving the provincial borders and as of next year, this hospital will be part of the Northern Cape Province, upon which time hopefully the hospital infrastructure can be upgraded.

Kagiso Health Centre

Without another precarious gravel road to cut distances down, we only made it to Ganyesa and Tshwarangano on the first day. But we also briefly stopped over at the Kagiso Health Centre close to Tshwaragano Hospital. This almost-new health centre is currently run by nurses as there are no doctors to work there. It was planned to be upgraded to a hospital but those plans have now been shelved because of political quagmires. The centre is eerily empty as brand new equipment lies around wrapped and waiting to be used and waiting room chairs sit empty. With the health crisis in the rural areas so grim, it is depressing to see such a facility just sitting there empty when it could help so many people fully staffed.

On our second day, we were scheduled to visit three hospitals – Vryburg, Schweizer-Reneke and Taung Hospitals.

Vryburg Hospital

We started in Vryburg, where we were conveniently staying, so the hospital was just down the road. The Vryburg Hospital is a sweet little facility that is fully equipped for a rural hospital – and it’s close to town. As at the other facilities, we were shown it all, the female and male wards with AIDS and TB patients silently suffering with little privacy, paeds and maternity wards with tiny preemies all bundled in together in incubators, as well as casualty/OPD, X-ray, physiotherapy and the forensic medicine room where rape victims are seen and evidence taken. The hospital has also recently started an ARV programme, whose waiting room was full here - as it was everywhere we went that distributed ARV’s. While the government is slowly rolling out ARV’s to AIDS patients, they still only reach about 20% of the AIDS victims in the country and in order to enrol, patients must prove that they can stick with the treatment and attend counselling sessions. When the nearest hospital is 50 miles away, it’s not an easy feat.

We briefly pulled the doctors of the hospital away from their rounds for tea. The hospital presently has four doctors - one Cuban doctor (the SA government recruited a slew of Cuban doctors to come in the 1980s), an Indian doctor, an Africaans doctor and one medical student doing his rural rotation. They all voiced their concerns about staffing levels and the isolation of their practice. The Cuban and Indian doctor had been working in the district for 10 years. For a long time they only had two doctors working at this hospital, and at times have had only one toiling away on his own.

Schweizer-Reneke Hospital

About 70km from Vryburg is Schweizer-Reneke Hospital. This hospital has been struggling with staff and for a time had no doctors, just nurses. But when we arrived, they had recently received a boost with the arrival of three Congolese doctors and three Iranian doctors. The government has just recruited about 40 doctors from Iran to come and work in the rural areas in South Africa (it seems that Iran has a surplus of doctors). We met one of the Iranians as he came through in route to sort out a bank account, having just arrived at the hospital the day before. He looked out of place with his snazzy shoes and psudo-suave demeanour. Trying not to focus too obviously on his obvious toupee, I heard him say that all the doctors under 30 had received a letter three years ago looking for doctors in rural South Africa, and now here he is. He seemed fascinated by the idea that I would leave America to come and settle here. “Why?” he asked, “would you leave the opportunity in America to come here? I would love to live in America.”

Taung Hospital

Taung Hospital was the last stop for the day. Taung is a lovely town. The hospital is the largest in the district and has very close links with Wits University. It is a modern hospital with lovely wards and grounds, including a tennis court for the doctors to get some exercise. They have a large and comprehensive ARV unit and have recently started a food garden which the patients are actively involved in (these are the kind of health projects that RHI gets involved in). A very enthusiastic Indian doctor showed us around the facilities along with the head matron (nurse). While the Indian doctor held my ear with complaints on how funding for RHI could be better and the ideas he has for future projects, we toured the wards, at this point used to the sight of patients in their beds and the doctors and nurses at work. Taung even has tele-medicine facilities, a TV with camera housed in the radiology department that can be linked up with other medical centres around the province, although we learned that because none of the other facilities’ cameras have been working, they are considering just moving it to the board room to use for meetings.

Our last day was dedicated to the Christiana- Bloemhof complex of hospitals.

Christiana Hospital

Christiana Hospital is a small on the outskirts of the small town of Christiana. It had one doctor on duty when we arrived. His Indian colleague had gone home on leave for a few weeks. Due to the fact there are only 2 doctors on staff, the hospital can only run one ward and the casualty/OPD. They do not have x-ray on site and have to refer their patients 50km away to Bloemhof Hospital, where they transport all the patients that need x-rays once a week. Just pray you don’t break your leg on a Thursday if the x-ray day is Wednesday.

Bloemhof Hospital

Further along the N12 is Bloemhof Hospital. Boemhof is a very small 15-bed hospital with a general ward and small maternity ward. The hospital is along a national road and therefore regularly receives patients involved in accidents along this stretch of highway. They recently had no doctors after the two doctors here resigned, apparently two young guys that just couldn’t take it anymore and up and left both at the same time. When we visited, we met the newly-recruited Iranian doctor (now the sole doctor at work here) on his second day at work, touring the pharmacy and trying to figure out what drugs were available to him here in this strange country in this hospital on the edge of nowhere. As the head matron told us, they were having some language barriers - the mix of African, English and Iranian accents and dialects must have been an effort.

Came back to bustling Joburg after Bloemhof. My new endeavour is learning how to rock climb. Been bruised and battered, but haven’t fallen off a cliff yet.

Off to a hospital in Limpopo, on the border with Zimbabwe, this week.